Wiki Question on 99203 & Consultation Code/ Same date of service

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EK226

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Hi everyone,

I have a question about services performed on the same date by two different doctors (at the same practice).

The patient saw the first doctor for a new patient visit due to a left distal radius fracture. The doctor then referred her to a board certified specialist located at the same factility. The specialist saw the patient, and it was then determined the patient needed to have surgery.

Both doctors want to bill 99203 since it was a new patient visit, but can the same code be billed on the same day since they are two different doctors? Shouldn't the specialist bill with a new patient consultation code since the patient was referred to this doctor for his opinion/advice on the siutation?

Any suggestions?
 
If they are different specialties then it sounds to me that it would be correct to have 2 new patient visits for this same date of service.

It doesn't sound like a consult to me, it sounds like the first doctor recognized the patient needed more specialized care than they could offer so as you stated they referred the patient to the specialist with the intention that the specialist would take over that piece of the care.

Laura, CPC, CEMC
 
Hi Laura,
thank you for getting back to me about this. From what I have been told, both of these doctors are from different specialties. I am trying to find something in writing that verifies it is appropriate to bill new patient codes and not consult codes on the same dos if the physicians are in two different specialties.

I have been looking through the CPT manual, and also my step-by-step coding book (by Carol Buck) would you happen to know if there is somewhere else to confirm this?

Thanks,
 
In the E/M section of CPT, the very first page gives the definition of a new patient.

"new patients: have not received care from the physician or any other physician in the same practice within the same specialty in the previous three years (99201-99205)"

Since they are in different specialties you really need to think of them as you would completely separate practices. If he had sent the patient to an outside ortho you would have no idea what that provider billed or vice versa, and it wouldn't matter because the billing doesn't affect you. It is the same thing within a group when they are credentialed as different specialties.

Hope this helps,

Laura, CPC, CEMC
 
Hi Laura,

yes, this does help. I did see on page 2 that there is a decision tree for new and established patients, I think the decision tree helped me to visualize the whole picture...

thanks!
 
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